Why does the global health issue with fewer burdens receive the most U.S. global funding?

In the U.S. Global Health Budget Request for 2015, HIV/AIDS accounted for 54% of the total requested $8.1 billion (See Figure 2 Below). (Wexler and Kates, 2014) In addition, the Global Fund requested 17% of the total, which also provides assistance to HIV/AIDS efforts. In 2015, HIV/AIDS incidence has significantly decreased and prevalence has stabilized, so why does it receive the most funding when perhaps it is not the most pressing global health burden? For example, nutrition has only a request of 1%, and yet, malnutrition is possibly the biggest underlying cause of infectious diseases and child mortality globally. In addition, the rise of noncommunicable diseases is becoming the new global epidemic, and it is not even on the 2015 request. What has influenced this priority setting and resource allocation, so that the actual realities of public health burden are basically ignored?

Well, there isn’t a clear answer to this question, but I will offer some possibilities. In the Millennium Development Goals (MDGs), only three goals pertain to health: MDGs 4, 5, and 6. In MDG 6, the first disease mentioned to combat is HIV/AIDS, followed by malaria, and “other diseases” as vague as that is. (UN Millennium Development Goals) The MDGs were composed in 2000 when HIV/AIDS was a much greater global health burden and global security threat with individuals in less developed countries having less access to antiretroviral medications. In 2000, maternal and child mortality were significantly higher; these mortality rates remain a critical issue today, but have been greatly reduced, which is why maternal and child care should have been given a larger request than 9% in the 2015 U.S. budget request. (Wexler and Kates, 2014) It is definitely possible that the MDGs have shaped the budget request for 2015 and in past years because of the great demand to fulfill these goals by the end of 2015. It is also reasonable to guess that HIV/AIDS has received to more funding because it has had more traction throughout its history due to activists, celebrity support (ex. Magic Johnson, Elton John, Alicia Keys, etc.), and specialized funding and organizations such as PEPFAR and UNAIDS, and many more. I don’t think that there are many nutrition or noncommunicable disease activists, or if there are, they definitely don’t have as much ammunition as the people in the HIV/AIDS sector’s corner. Based on this information, there is a need for balance or “harmonization” as Jeremy Shiffman would argue within the U.S. Global Health Budget Request for 2015 between the actual realities of the global health burden that are pressing with the global burdens that are trendy and receive a lot of attention and support. (Shiffman, 2009) This balance can help ensure that global health burdens are reduced and new epidemics be maintained from becoming even larger scale issues.

8564-figure-2

References:

Wexler and Kates, 2014. http://kff.org/global-health-policy/issue-brief/the-u-s-global-health-budget-analysis-of-the-fiscal-year-2015-budget-request/

Millennium Development Goals. http://www.un.org/millenniumgoals/

Shiffman, 2009.  http://www.who.int/bulletin/volumes/87/8/08-060749/en/

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